Malignant mediastinal germ cell tumor revealed by routine health examination with a satisfactory postoperative course ; a case report

Abstract

A 25-year-old man was admitted to our hospital because of an abnormal shadow on a routine chest roentgenogram. A CT scan of the chest showed a mass in the anterior mediastinum. Laboratory examination revealed elevated levels of AFP (971.6 ng/ml) and HCG (16.3 mIU/ ml), which were highly indicative of malignant germ cell tumor. Imaging examination indicat-ed that the mass was resectable, so surgery was performed prior to chemotherapy. On the 16th day after the first chest X-ray, the patient underwent median sternotomy. A mass infiltrated the pericardium and left lung. Therefore, the mass was extirpated along with the thymus and part of the pericardium and left lung. The tumor was 6 × 4.5 × 2.5 cm in size and weighted 110 g. Histological examination revealed an admixture of mature teratoma, seminoma, yolk sac tumor and embryonal carcinoma. Starting on the 7th postoperative day, the patient received three courses of PVB therapy. Both AFP and HCG became negative in the 1st postoperative month. The patient is alive with no sign of recurrence more than two years after the operation.